Consultant – Operational and Capacity Building Support for Health Insurance Implementation in FCT at Palladium Group

Palladium is a global leader in the design, development and delivery of Positive Impact – the intentional creation of enduring social and economic value. We work with corporations, governments, foundations, investors, communities and civil society to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits.

We are recruiting to fill the position below:

Job Title: Consultant – Operational and Capacity Building Support for Health Insurance Implementation in FCT

Subject RFP #: TO7/217727/Consultancy/Fixed Price Contract-2020-0002
Location: Abuja (FCT)
Project: Integrated Health Program, FCT Activities
Country of Performance: Nigeria

Purpose

  • Palladium invites applications from suitably qualified individual consultants to provide technical support to the FCT Health Insurance Scheme (FHIS) to ensure effective design and implementation of the FCT Health Insurance Scheme (FHIS). In this Request for Proposal, Palladium expects offerors to develop a custom solution and proposal to Palladium for consideration. Bidders are required to provide justification for the work proposed or methodology to be adopted. This will be a Best Value procurement.
  • This consultancy aims to provide technical assistance to roll out and operationalize the FCT Health Insurance Scheme (FHIS) by embedding an experienced health insurance expert within FHIS to guide health insurance technical operations and to build capacity of the team. To support the agency to implement an effective health insurance scheme, the Technical Assistance consultancy will provide technical support towards development and effective execution of technical processes, especially processes contained in the SHIS laws, operational manuals, and other documents as may be required and provide capacity building and hands-on support to the staff of the agency throughout the consultancy period. The IHP work plan contains specific deliverables related to developing an enrolment plan and providing capacity development on claims management and reimbursement functions.

Type of Contract:

  • This is a firm fixed price deliverable-based contract. The consultant is expected to satisfactorily accomplish the deliverables before he/she gets paid for that deliverable. The IHP Chief of Party reserves the right to confirm if a deliverable is delivered adequately or otherwise. No price change is expected after contract is signed. IHP will not pay for cost of any deliverable that is not complete, of quality or on time.

Anticipated Contract Term:

  • The anticipated performance period for the consultancy is December 10, 2020 to April 30, 2020. As a firm fixed price consultancy based on deliverables, Palladium will only pay for deliverables that have met the standards and expectations of the program and which is also delivered within assigned timelines.

Project

  • The Integrated Health Program (IHP) is a USAID-funded five-year project with a mandate to improve health systems, improve access to and increase quality of primary health care in designated states (Sokoto, Bauchi, Kebbi, Ebonyi and FCT). IHP is working with state governments to strengthen and advance operationalization of State Health Insurance Schemes toward attainment of universal health coverage. IHP aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems through policy development and implementation, with an emphasis on voluntary, rights-based health programs.
  • IHP will help public health and policy leaders attach higher priority to their national and sub-national health needs, secure sustainable financing, advance health equity, and monitor policy implementation to ensure gains stay on track. IHP aims to secure long-term enduring change by working with coalitions both inside and outside of health and showing common cause with neglected populations and other development actors. Central elements of IHP revolve around building in country capacity, institutionalizing achievements of past investments, and promoting country ownership of programs and initiatives.
  • The decentralization of the National Health Insurance Scheme (NHIS) and consequent establishment of State Health Insurance/Contributory Schemes (SHIS) across the country is one of the key policy thrusts of the Government of Nigeria aimed at reforming the health financing landscape for a stronger health system and improved health outcomes. To this effect, IHP is supporting focal states to put in place necessary design elements and operational structures for the effective roll-out and implementation of the various state contributory health schemes (SCHS).
  • The FCT Health Insurance Scheme (FHIS) previously (FCT Health service scheme) was launched in 2009 to coordinate and regulate health care financing reform (Social Health Insurance Scheme), operated on the principle of solidarity, risk sharing and pooling of resources for the provision of affordable, accessible and quality health care to all FCT residents. The FHIS strives to improve financial risk protection of FCT residents towards achieving universal health coverage and has enrolled about 119,000 beneficiaries from the FCT civil service in the Scheme through a network of Health Maintenance Organizations (HMOs). The FHIS establishment bill, still undergoing legislative processes, enshrines the mandatory participation of all FCT residents in the Scheme. Consequently, the FHIS is desirous of developing structures, systems and processes that will enable its expansion of coverage to the private and informal sectors.
  • In support of this objective, the USAID-funded Health Policy Plus (HP+) project supported review of FHIS’ benefit package, actuarial costing of the reviewed benefit package and design of key technical processes. USAID-IHP now wishes to build on this platform to support the FHIS in implementing the designed technical processes, develop required standard operating procedures and build the FHIS capacity to manage health insurance operations. In addition, as the FHIS expands its coverage, USAID-IHP will provide technical support to enhance the Scheme’s ability to collect, analyze and use encounter and claim data to enable strategic decision making.
  • USAID-IHP is seeking a qualified consultant to be embedded within the FHIS to provide guidance on the implementation of health insurance technical operations and to build the team’s capacity to progressively take on these activities.

Timeline:

  • Palladium will set up an evaluation committee who will meet to review all applications received within two weeks after the application period has closed. Top candidates may further be invited for an interview by the evaluation committee which will be conducted a week after the first evaluation. Depending on availability of the members of the evaluation committee and the exigences of the program, evaluation may be conducted at times which may be shorter or longer than stated here.
  • Palladium will most likely issue the contract to the successful contractor from this process within 30 to 60 days after submission. Palladium’s ability to issue such contracts may be contingent upon USAID approval and when donor approval is required, timelines for contract award may be longer than stated. Palladium hopes that the services to be rendered on this consultancy will commence on December 10, 2020.

Background

  • The implementation of the State Health Insurance Scheme in states is an essential mechanism for ensuring improvement in attaining Universal Health Coverage (UHC) in the country. These schemes will ensure a stable, predictable and sustainable source of funding for the schemes.
  • Additionally, the successful implementation of the schemes will ensure universal access to quality, equitable care especially to reproductive health/family planning, maternal health, newborn health, child health, nutrition and malaria services.
  • There is considerably low technical capacity to implement and manage these schemes at the state level, and therefore it is essential to strengthen operational and technical capacity of FHIS to implement efficient and effective health insurance operations that will ensure coverage and protection to the entire populace.

Roles and Responsibilities

  • The consultant will provide technical support for streamlining the FCT Health Insurance Scheme’s operations and ensuring necessary structures and processes are in place to guarantee delivery of services to enrolees, facilitate expansion to the informal sector, improve quality processes and build capacity of FHIS staff to manage the scheme.
  • The consultant is required to be embedded in the FCT functioning directly in the FHIS office for the period of consultancy.

Services description
The major products and outcomes of this assignment are:

  • Review FHIS’ technical documents, including but not limited to, the FHIS Operational guidelines, Benefit Package, Provider Payment Mechanisms Guidelines with the aim of identifying immediate processes and structures that need urgent attention.
  • Develop (and where applicable, finalize) documents, technical processes and tools that are needed for FHIS operations
  • Facilitate the set-up of necessary structures for the implementation of the FHIS, in keeping with the operational guidelines and FY21 annual operation plan.
  • Support the institution of a quality assurance system for the FHIS and support ICT linkages across the different departments in the FHIS
  • Support the institution of a claims review process for the FHIS
  • Support the development and implementation of a performance management system for the health insurance operations and facilitate regular performance reviews with a view to achieving continuous quality improvement in planning and execution.
  • Develop and support the implementation of an informal sector enrolment plan, including marketing strategy and demand creation, targeting prioritized population groups in the state,
  • Build the FHIS’ staff capacity on managing health insurance operation through a mix of on the job training, mentorship and engagement in the development and implementation of technical and operational documents.

Deliverables
The major products and outcomes of this assignment are:

  • 25% implementation of the annual operation plan for prioritized state sub-population groups
  • Completed skills development training to SHIS on claims management and reimbursement processes as evidenced by demonstrated increase in staff capacity
  • At least one cycle of claims review conducted with defined triggers for querying claims, investigation of queried claims and analysis of impact of claims reimbursement trends on utilization and pricing of services
  • Performance management system for SHIS operations established and functional, with indicators and targets developed and at least 1 performance management review cycle conducted
  • Quality assurance system established for SHIS operations and functional, and at least one quality assurance review conducted
  • Final consultancy report.

Eligibility Requirements

  • A good first degree or its equivalent from a reputable University in Medicine, Sciences, or numerate disciplines such as Actuarial Science, Statistics, Insurance, etc.
  • Post graduate qualification in Management, Public Health, Health Management, Health Economics, Insurance, or other related fields
  • Certification in and/or professional membership of Health, Management and Health Insurance related bodies shall be an added advantage
  • Minimum of 7 years’ experience implementing health insurance in Nigeria or related settings.
  • Expertise in claims management and reimbursement best practices
  • Experience in developing and delivering capacity building workshops; including on health insurance implementation
  • Experience in contributing to the development of health insurance strategic plans and managing teams to implement health insurance strategic plans
  • Good understanding of current health financing reform initiatives in Nigeria especially the subnational level
  • Experience carrying out similar assignments in Nigeria particularly at the sub-national level.

Required Technical Competencies:

  • Expert in insurance management and operations
  • Familiar with results-based management
  • Knowledgeable about ICT systems for insurance management
  • Knowledgeable about change theories and health system approaches
  • Expert in knowledge management and skills development.

Required skills:

  • Analytical skills
  • Leadership and coaching skills
  • Good interpersonal skills
  • Good communication skills (negotiation, moderation, representation, presentation of results)
  • Strong oral and writing skills in English.

Due Diligence requirements

  • Palladium conducts a due diligence search as part of our partner vetting and selection process. Please see Attachment A for a sample of the due diligence form.
  • Any individual or Company must complete Due Diligence Questionnaire if selected for Award within 5 days (See Attachment A for the Due Diligence Questionnaire)
  • Restrictions for debarred or otherwise prohibited companies.
  • As a USAID funded project, IHP does not partner with any debarred individuals or companies. Therefore, candidates and companies will be subjected to the approved systems of search which Palladium uses for vetting and certifying that potential contractors are not debarred.
  • Availability of Specific Registrations or Licenses to perform the Service.
  • For Companies Application, contractors are required to submit their certificates of incorporation and any other industry certificates which enables them to operate in Nigeria and in the industry of this SOW.
  • The Company must have a DUNS number or obtain one within 5 days of being notified of selection (see Attachment C for instructions for obtaining DUNS number).

Application Closing Date
25th November, 2020.

How to Apply
Interested and qualified candidates / bidders are expected to submit both technical and financial bids and in two separate emails to: consultancy@ihp-nigeria.com stating as part of the subject matter of the email whether “Technical bid” or “Financial bid” and also quoting the RFP number as it appears on the cover page. Applications received will have a validity period of six months.

Click here for more details concerning this consultancy and other associated application tools

Note: No late application will be received after the deadline.

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